Sutter Health Reimbursement Analyst in Roseville, California

Position Overview:

Under the general guidance and supervision the duties of this position include completing accurate annual Medicare cost reports for complex acute hospitals, including those with distinct part psychiatric, rehabilitation, SNF, HHA, CORF, organ transplant, resident and RHC programs. It is incumbent upon this position to ensure the reports are in full compliance with current laws and regulations. These reports include all required supplemental data reports such as: (a) CMS Form 339, (b) Wage Index data, (c) Medicare bad debts and (d) physicians compensation information.

Duties include completing accurate annual California Department of Health Services (DHS), Medicaid (Medi-Cal) cost reports and all related supplemental reports such as: (a) Medi-Cal supplemental report for acute hospitals under contract and non-contract arrangements, (b) County Medical Services Program (CMSP) and (c) Rate Development Branch.

This position works closely with Medicare and Medi-Cal Auditors during audit process providing requested supporting documentation.

Duties include reviewing up to four Sutter Health affiliates’ submitted monthly contractual calculations with the supervision and review by the Reimbursement Manager and/or Sr. Reimbursement Specialist.

The person in this position will help prepare and submit special reports required by the California DHS and Medicare fiscal Intermediaries in conjunction with cost report submission and settlement analysis.

Other special projects will be occasionally assigned.


Education :

Bachelor Degree in Business Administration, Accounting, Finance is required or equivalent combination of education and experience.

Experience :

Must have experience in healthcare, auditing, working, analyzing and completing Medicare cost reports (CMS Form 2552-96 and CMS Form 339), and Medi-Cal cost reports with related supplemental schedules (A & I Forms). Must have knowledge in the application and treatment of revenues and expenses, and various payment methodologies used by the Medicare and Medi-Cal programs. This level is typically obtained in 3 to 4 years of direct experience.

Must have the experience and thorough understanding of the correct application and calculation of Medicare and Medi-Cal entitlements, applying current Medicare and Medi-Cal laws and regulations governing facility entitlements under Title XVIII and Title XIX for Acute Hospitals, Skilled Nursing Facilities (SNF), Home Health Agencies (HHA), Rural Health Clinics (RHC), Psychiatric Hospitals, Rehabilitation Units, and hospitals with medical education and organ transplant programs.

Must have experience working and understanding the hospital accounting systems, accrual basis of accounting, audit processes, and working paper presentation and cross-referencing.

Must have experience in the application and use of licensed Medicare/Medi-Cal cost report software programs.

Must have a good understanding of accounts receivable valuation methodologies and calculation of contractual allowances.

Must have experience using personal computers and related software applications such as (a) spreadsheets, (b) word processing, (c) e-mail and (d) cost reporting software. Experience with the MedSeries4 mainframe system is considered a plus.

Knowledge :

Must be knowledgeable and understand all of the Medicare and Medi-Cal compliance cost reporting requirements.

Must be knowledgeable and understand the laws and regulations governing Medicare and Medi-Cal reimbursement affecting Acute Hospitals, Psychiatric Hospitals, Physical Rehabilitation Units, SNF, HHA, RHC, and inpatient and outpatient payment systems under Title XVIII and Title XIX of the Act.

Must be knowledgeable and understand hospital accounting system and the accrual basis of accounting.

Must know how to use personal computer and related applications such as (a)spreadsheet, (b) word-processing (c) e-mail and (d) cost reporting software application. Knowledge of the MedSeries4 system is considered a plus.

Must know how to write brief and concise reports.

Must know how to create and cross-reference working papers with supporting documents.

Must know and understand how to apply and use statistical models.

Special Skills/Equipment :

Strong organizational and planning skills.

Strong written, verbal and interpersonal and presentation skills.

Strong reading and comprehension abilities to understand and interpret complex laws and regulations issued by CMS and California DHS such as Medicare and Medicaid regulations published in the Federal Register.

Strong analytical, evaluative and statistical skills.

Ability to handle shifting priorities and multiple projects simultaneously.

Must have the ability to adhere to critical deadlines.

Must be knowledgeable and efficient in the use of personal computers and related applications.

Must have a valid California Drivers License.

Must be able to work with very minimum supervision.

Organization: Sutter Health System Office

Employee Status: Regular

Benefits: Yes

Position Status: Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.